Hormone Replacement Therapy: Friend or Foe?

Menopause is a natural stage of life for women. It occurs when the ovaries stop making the hormones progesterone and estrogen. Hormone replacement therapy (HRT) can make up for some of this loss. You may get estrogen alone if you no longer have a uterus. Or if you still have a uterus you may get HRT as a combination of estrogen and progesterone if you still have a uterus. Some women take HRT to ease side effects of menopause. These may include hot flashes, night sweats, and vaginal dryness. Others have taken it to reduce certain health risks linked with menopause. HRT has been available for more than 60 years. Still, much controversy surrounds its health risks and benefits.

Studies confirm that HRTgreatly reduces the risk for osteoporosis and can ease many symptoms of menopause. However, many other things we thought we knew “for sure” about HRT have now come into question.

The results of a large randomized study on combined HRT (estrogen plus progestin) versus placebo (a “sugar pill”, which has only inactive ingredients) were published in the Journal of the American Medical Association (JAMA) in 2002. The study group stopped the trial before it was finished because of the results. They wanted to alert participants that the overall health risks from HRT outweighed its benefits. In particular, there was an increased risk for invasive breast cancer.

Sponsored by the Women’s Health Initiative, this study followed 16,608 postmenopausal women ages 50 to 79 who still had a uterus. Each woman was randomly assigned to a group taking either combined HRT or a placebo. Researchers found that the overall risks from HRT were quite small. But compared with women taking the placebo, women taking HRTshowed higher risks for:

• Invasive breast cancer

• Heart disease

• Stroke

• Blood clots

The chart below shows the overall increases in risk for each condition. Most of the women taking HRT in the study did not develop these problems. However, their overall risk was greater than that of the women in the placebo group.

Women in the HRT group did have some decreased risks, including a lower risk for colorectal cancer and hip fracture.

None of these results necessarily apply to women taking lower dosages of these medications, estrogen alone (used only in women who don’t have a uterus), or hormones using a transdermal patch.

Researchers found no significant difference between the 2 groups with respect to the rate of noninvasive breast cancers (DCIS, LCIS), endometrial cancer, lung cancers, or other cancers. Also, the death rate in those with coronary heart disease and breast cancer was not higher in one group over the other. This may be partly true due to the relatively short follow-up time of the study.

Do the results of this study mean that women should never use HRT or that all women who are currently using this medication should stop? No. This study showed that the overall, absolute risks of HRT remain relatively small. These results, and the results of other studies, seem to show that HRT should not be used to prevent heart disease in healthy women or in women with existing heart disease. Women and their doctor and genetic counselor should continue to map out each woman’s personal risk for:

• Breast cancer

• Colon cancer

• Stroke

• Blood clots

• Heart disease

• Osteoporosis

Talk to your doctor about which personal risk factors you can change to lower your risk for disease. These may include:

• Obesity

• Tobacco use

• Inactivity

Weigh your own discomfort from hot flashes, night sweats, vaginal dryness, and other menopausal symptoms. Look at many methods for easing these symptoms before making an informed, personal decision that is best for you.